Clinical Denials Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Capacity to evaluate reasons for denials and trends to uncover opportunities for enhancing processes.

• Exceptional verbal and written communication abilities to effectively engage with healthcare providers and articulate appeal arguments.

• Strong attention to detail to guarantee meticulous review and analysis of denied claims and medical documentation.

• Robust problem-solving capabilities to formulate effective appeal strategies and address denial challenges.

• Knowledge of medical terminology, coding standards, and reimbursement policies to evaluate denial reasons and identify appeal opportunities.

• Flexibility to adapt to evolving payer policies, regulations, and reimbursement criteria.

• Review denied claims to ascertain denial reasons and inconsistencies.

• Examine medical records, billing documents, and payer guidelines to construct appeal arguments.

• Collaborate with healthcare providers to collect additional documentation and evidence for appeals.

• Record appeal activities, correspondence, and outcomes for tracking and reporting purposes.

• Monitor denial trends and provide insights to revenue cycle teams to avert future denials.

• Engage in denial management meetings and share insights to enhance denial prevention strategies.

• Keep abreast of payer policies, regulations, and reimbursement guidelines pertinent to claim denials.

⛳️ Requirements

• Bachelor's degree in healthcare administration, nursing, health information management, or a related discipline.

• Clinical designated nurse or RN credentials (denials/CDI).

• A minimum of 2-3 years of experience in healthcare revenue cycle management, medical billing, claims processing, or denial management.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health, dental, and vision insurance.

• Opportunities for professional development and continued education.

• Flexible work schedule and remote work options.

• Supportive and collaborative work environment.